Provider Demographics
NPI:1043314735
Name:BROOKS, MARTHA JANE (LCSW MSSW)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:JANE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LCSW MSSW
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:J
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:333 CAMPBELL DRIVE
Practice Address - Street 2:
Practice Address - City:SNEEDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37869
Practice Address - Country:US
Practice Address - Phone:423-733-2216
Practice Address - Fax:423-733-2450
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLCSW1015104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
12850OtherUBH JOHN DEERE
1002526OtherCIGNA MCC
132697OtherVALUEOPTIONS
3085273OtherMAGELLAN SUMMIT
12850OtherUBH EMPLOYER
12850OtherUBH SENIOR
3085273OtherMAGELLAN NAVIGATOR
138847OtherHANCOCK CO ANTHEM PREF
3085273OtherMAGELLAN PINNACLE
334969OtherGROUP VALUEOPTIONS
12850OtherUBH HEALTHPLAN
138847OtherHANCOCK CO ANTHEM PROF
3085273OtherMAGELLAN PINNACLE
12850OtherUBH SENIOR